December 9, 2019

When constant heartburn is something more

by
Man sitting on couch after eating a meal feeling for constant heartburn.

Constant heartburn can be a sign of a more significant issue. Here’s when to seek help.

Experiencing heartburn every now and then is normal. Sometimes the uncomfortable sensation comes on after eating a spicy meal, for example. However, if you get heartburn repeatedly, the constant irritation could lead to long-term damage and more serious conditions.

We chatted with Chetan Aher, M.D., a general surgeon with Vanderbilt Health, to find out why we should be paying attention to heartburn symptoms — and how to know when to seek treatment.

Why is adequate heartburn treatment so important?

Constant heartburn can exacerbate conditions like asthma, create a chronic cough, affect your sleep, cause difficulty with swallowing or give you a hoarse voice. In addition, long-term irritation caused by acid reflux can lead to the development of adenocarcinoma, a type of esophageal cancer. “This is rare,” Aher stressed, “but the incidence is increasing — so people who have significant symptoms and people who are not controlled by medication are at an increased risk.”

How do you know you’re experiencing heartburn and not an emergency?

The first sign of heartburn is usually a burning sensation that begins behind the breastbone. But since the sensation involves discomfort in the chest, it can raise the concern of whether your heart is in trouble. Whether or not you suffer from constant heartburn, taking precautionary steps from the start may save your life.

An important thing to remember is that heartburn doesn’t move. The exception may be a feeling of burning or bile rising in your throat. “Heartburn doesn’t radiate to your shoulder. You don’t feel it in your jaw,” Ahern explained. Pain, tightness, or pressure that spreads, however, could be a sign of a heart attack.

If you’ve experienced heartburn before, had a spicy meal or recognize a similar sensation, this may be another case of acid reflux. “However, if somebody is having chest pain that they’re not used to and that they feel uncomfortable with,” Aher said, “by all means, go to the emergency room to be evaluated.”

When is heartburn a reason to schedule a visit with your doctor?

If you reach for an antacid in your medicine cabinet once a month, that’s not a reason to worry — most people get the occasional heartburn episode. But Aher stresses that people should be able to enjoy a citrusy drink or a saucy dish. “If you can’t eat that because you’ve got heartburn,” he said, “that means you’ve got pretty decent heartburn, and you should have a workup for that.”

What are the next steps?

Treatment may be as simple as tinkering with the type of medication, dosage or timing. If medication changes don’t resolve anything, your doctor might refer you to a gastroenterologist. Your gastroenterologist may perform an upper endoscopy procedure to view the stomach and esophagus. This will help determine whether you have gastroesophageal reflux disease or GERD. GERD is often characterized by acid reflux that occurs at least once or twice per week.

“If somebody does have significant reflux and they feel like it’s life-limiting,” Aher said, “that’s the time to start thinking about surgical options.” If you do require intervention, know that there are innovative surgical procedures with minimal side effects.

If you experience frequent heartburn, it might be time to talk with a doctor about the causes and whether surgery might help. Call for an appointment with one of our Vanderbilt Reflux Care experts, at 615-322-2063.

Chetan Aher, M.D.

Chetan Aher, M.D., is assistant professor of surgery in the Division of General Surgery at Vanderbilt University Medical Center. His clinical areas of interest include surgical treatment of gastroesophageal reflux disease (GERD), obesity, hiatal hernia, achalasia and surgical weight loss. His research interests include outcomes after esophageal myotomy, changes in cognition after weight loss surgery, and the effect of quality and process improvement on patient care delivery and outcomes.